In the Oertel system the diet is combined with exercises, active or passive, to strengthen the heart. Steady walking exercise to strengthen the muscles of the heart is insisted upon, and walking slowly uphill and going upstairs are especially advocated. Oertel insists on the exercise being taken in the open air, and on its careful regulation by the physician, the amount being regulated by the state of the patient's heart, and by the presence or absence of anemia. The amount of fluid is reduced, and the excretory function of the skin is promoted by baths. Wasting of the muscles is prevented by an albuminous diet. In Oertel's diet the protein is given in the form of roast or boiled beef, veal, mutton, game, eggs. Fresh vegetables are given, as spinach and cabbage; stale bread, toast, rusk, and biscuits are given in 4 to 6 ounces almost daily. The fluids are restricted to 40 ounces in the twenty-four hours, which may be taken as tea, coffee, skimmed milk, water, claret, and hock. The daily dietary is as follows: -

Morning

1 cup of tea or coffee, with a little milk; altogether about 6 ounces. Bread, about 3 ounces.

Noon

3 to 4 ounces of soup (clear, not thick soup).

7 to 8 ounces of roast or boiled beef, veal, or game, avoiding pork and the fat poultry. Salad, or a light vegetable, avoiding potatoes, beans, peas, parsnips, carrot, or beetroot; a little fish (cooked without fat) if desired; I ounce of bread or farinaceous pudding (never more than 3 ounces). 3 to 6 ounces of fruit (freshly prepared) for dessert; avoiding puddings, suet, rice, tapioca, bread, sago, and macaroni.

It is desirable at this meal to avoid taking fluids; but in hot weather, or in the absence of fruit, 6 to 8 ounces of table water or light wine may be taken.

Afternoon

The same amount of coffee or tea as in the morning, with at most 6 ounces of water; I ounce of bread occasionally.

Evening

I or 2 soft-boiled eggs, or fish, avoiding mackerel, herrings, eels, salmon, and sardines. 1 ounce of bread; a small bit of cheese at times. Salad fruit. 6 to 8 ounces of wine with 4 or 5 ounces of water.

In the slighter forms of obesity it is found, if this diet is adhered to and ample exercise is taken, that the reduction of fat is usually satisfactory.

In the severer forms, the exercise has to be modified and the fluid consumed restricted, vapour and other baths being taken under the strictest medical supervision. Massage has here to replace exercise to a great extent.

The Ebstcin regime is a modification of the Banting method, containing more fat and less protein. Ebstcin contends that the ingestion of fat is useful in curing obesity, if combined with a greatly reduced administration of proteins and carbohydrates, as fat abates appetite and lessens thirst. The Ebstein diet is meagre. About one-half the usual amount of meat is allowed.

Breakfast

White bread well toasted, rather less than 2 ounces, well covered with butter; tea, 9 ounces, without milk or sugar.

Dinner

Soup made with beef marrow; fat meat with gravy, 4 to 5 ounces; a moderate amount of one of the vegetables allowed, viz., asparagus, spinach, peas, and beans. Two or three glasses of light white wine. After this meal a large cup of tea without milk or sugar.

Supper

An egg; a little roast meat with fat; 1 ounce bread well covered with butter; a large cup of tea without milk or sugar.

In Schweinger's modification of this method there is an entire suppression of fluids at meals. Whatever fluid is taken must be taken an hour or two after food.

Von Noorden's method differs from Oertel's in giving small meals at frequent intervals.

8 A.M. - Cold lean meat, 3 ounces; bread, 1 ounce; 6 ounces tea or coffee, very little milk. 10 a.m. - A lightly boiled egg. Noon - 6 ounces clear soup, without any fat. 1 P.M. - A small plate of clear soup, 8 ounces; lean meat or fish, 5 ounces; potatoes, 3 1/2 ounces; green vegetables; fresh fruit, 3 1/2 ounces; (no fluid).

3 P.M. - A cup of black coffee, 4 ounces.

4 P.M. - Fresh fruit, 7 ounces.

6 P.M. - A glass of skimmed milk.

8 P.M. - Cold lean meat, 4 1/2 ounces, with pickles; 1 ounce bread; 2 or 3 spoonfuls of fruit cooked without sugar.

The Carlsbad Regime

An interesting and useful account of the regime in vogue at Carlsbad is given by Mrs Ernest Hart in her book on Diet in Sickness and Health. Mrs Hart gives her personal experience as follows: - "It may be of interest to my readers who suffer from too great an abundance of fat to learn how I put theory into practice and reduced my weight 15 lbs. in three weeks. This result was obtained at Carlsbad, and the regime was as follows: - Rose at six, took three tumblers of hot Sprudel water, walking for about twenty minutes between each glass. Breakfast at eight, consisting of one or two small crescents of bread and a boiled egg, On alternate mornings a vapour bath with cold douche, or general massage of the bod)-. Dinner at one o'clock, consisting of a small amount of fish and meat or poultry, with green vegetables; no potatoes or sweets. In the afternoon a walk of from six to eight miles up the hills in a flannel dress. Supper at seven, consisting of a poached egg, or a small cut of cold meat. There is no doubt that I suffered from constant hunger on this diet, but under it my weight steadily diminished, and a feeling of lightness and well-being took the place of previous heaviness. Continuing the diet after I left Carlsbad, I lost another six pounds, and it was some years before the tendency to increase in weight showed itself again. I am quite certain that no one need fear becoming a ponderous size, a source of discomfort to themselves and of disagreeable impression to others, if they checked the beginning of obesity by suffering the small inconvenience of submitting to a restricted diet for a time".

A modification of the Salisbury diet is recommended by some writers. The essential idea lure is to limit the food and drink, and give the lean of meat, and an abundance of hot water. Two pounds of rump-steak, and I lb. of cod, together with 6 pints of hot water are given, as the daily diet for the first fortnight; for the next three weeks, 4 pints of hot water with other kinds of lean meat and fish are allowed, as well 1 little green vegetables and unsweetened rusk. For the following month the hot water is reduced to about one pint a day, and some crusts of stale bread, unsweetened biscuits, grilled meat or poultry, or game of any kind, and hock and claret with seltzer water, are allowed. Five grains of bicarbonate of potash are also prescribed night and morning. This system should only be tried in cases where there is every reason to regard the kidneys as sound.